Sanitation and gender – looking beyond the binary

Research has shown that the issue of transgender and intersex access to sanitation is under-addressed in the water, sanitation and hygiene development sector. Andrés Hueso and Priya Nath of WaterAid UK and Mamata Dash of WaterAid India, discuss the human rights issues at the heart of the matter, and what could be done.

Next time you are in a public place – a restaurant, a festival, an institutional building, a school or even your workplace – have a look at the toilets. Usually, what you will see is two sections: one for males, and one for females.

You may never have given it a second thought, but many people and communities struggle with this binary (one or the other) choice between female and male, with no room for anything that varies or lies in between. Members of the transgender and intersex communities may struggle with this choice every day. In some cases it may be that they do not identify with either gender category, so deciding where to go might be psychologically stressful or socially awkward. This can be an issue in schools, especially for students who are transitioning from male to female or vice versa.

In other cases, a person may be afraid or tired of being threatened, abused, harassed or attacked when they use the toilet of the gender that they do identify with. There have even been instances of access being denied.

Widespread violation of rights

Some may think this is a very isolated problem, but estimates – rough as they are, and with considerable variation – show a different picture. One, based on medical records, estimates 1 in 2000 people are born in the intersex category; another study (pdf) found that 0.6% of the US population identifies as transgender; and India has a population of 500,000 transgender people, according to census figures.

Beyond the numbers, the challenges that transgender and intersex people face to accessing public toilets should be seen as a violation of several human rights, including the right to sanitation, the right to privacy and the right not to be discriminated against.

Within the development community, in the sanitation sector we have rarely looked at gender beyond male and female. To be honest, we only started looking meaningfully at male vs female dimensions of sanitation recently. Publications, manuals and papers about menstrual hygiene or violence against women linked to WASH are, for the most part, less than a decade old. Non-binary considerations have largely been absent, with perhaps a few exceptions.

Forging a path

Fortunately, transgender communities and activists have not been waiting for us and have been advocating for solutions. An example from Indian activists for instance, is third gender toilets designated only for transgender people. This has already yielded results, with different city authorities promisingto install toilets for transgender people. One example where this was realised is the bus station in the city of Mysore, where a toilet for transgender people was opened up very recently.

Fitting to context

However, there is not a ‘one size fits all’ solution. Although creating an additional category of toilets – transgender toilets (also called third gender toilets) – seems so far to have been prioritised in some places, some within transgender communities are critical of this approach. Although transgender toilets may provide a safer way to access sanitation, there are substantial trade-offs in that they may reinforce stigma and even result in people being banned from accessing the toilets of the gender they identify with.

The struggle for identity and dignity is central to the efforts of transgender activists and groups. The uncertainty on how the different toilet configuration will play out regarding those dimensions explains the lack of consensus on the solutions.

Context dynamics also play a crucial role. Transgender toilets may be an option in the South Asian region, where transgender communities have, in some places, had social recognition (or at least acknowledgement) for centuries, and, in some cases, are legally recognised as a ‘third gender’ – although the term goes not without controversy. In other contexts, such as in some African countries where transgender people are being prosecuted, this kind of facility is probably not even an option. One solution that might work there is to have one or more unisex cubicles (potentially also accessible) alongside male and female toilet blocks.

Another alternative gaining popularity in Western countries is gender-neutral toilets, where people can access all toilets irrespective of their gender. This option is not recommended, however, in contexts and places where it may increase the risk of violence against women or transgender people, or where it is deemed culturally inappropriate. Even where that is not the case, the solution might not be as straightforward as it seems. The tumultuous experience in London’s Barbican Centre, where the idea was retrofitted into old infrastructure (including urinals!), is a good example of this.

The root causes of these challenges are primarily discrimination and stigma. It is therefore very clear that toilet infrastructure and configuration is just one small dimension of the issue. Awareness-raising and legislative recognition and protection are crucial means to, among other things, help fulfil the rights of transgender people to sanitation, be it legally entitling them to access the toilets for the gender they identify with, or combating the stigma and prejudice that prevents that access.

Structured learning

At WaterAid, we are starting to learn in a structured way about this important topic. We have conducted a review of literature and media, and will be presenting the results at the WEDC conference this week (26 July 2017). We have learned a lot, but the most relevant finding was that very little evidence exists on the problems transgender people face to accessing toilets, let alone on what the best solutions are. More importantly, we have learned we need to work closely with transgender and intersex people to understand their specific sanitation needs and the barriers they face, and how we can best contribute to the move towards solutions that uphold their rights, dignity and security.

Our mission of reaching everyone, everywhere, and our commitment to tackle inequalities, requires us to challenge our own blind spots, prejudices and biases. This is not always easy for organisations or individuals, and we must recognise and respect different legal and cultural environments while upholding our commitment to work towards the progressive realisation of the human rights to sanitation and to water for every person everywhere.

We are looking forward to making progress on this front, with other sector organisations and academics interested in or open to the topic. Collectively, we need to start engaging and consulting alongside transgender and intersex communities, understanding the issues they face, jointly trialling potential solutions, and studying the results.